CH7: VOICE Flashcards
Ventricular/ false vocal folds do not vibrate during normal phonation and used only during ____?
activities such as lifting and coughing
what folds separate the pharynx and laryngeal vestibule?
aryepiglottic folds
Primary cranial nerve for laryngeal innervation
cranial nerve 10: vagus nerve
This vocal structure is cartilage attached to hyoid bone and covers trachea so that food and drink go to esophagus.
EPIGLOTTIS
These laryngeal muscles are responsible for controlling vocalization
intrinsic laryngeal muscles: thyroarytenoids, cricothyroids, cricoarytenoids, transverse oblique arytenoids
These laryngeal muscles elevate and lower larynx position
Extrinsic Laryngeal Muscles
Mean Fo range for kids 7-8 years old
281-297 HZ
Max Phonation Time….what happens from 7 to 15 yrs of age
sustaining ah…doubles in time from 7.5 to 15 seconds
MFF for men
average is 125 HZ (Range is 100-150)
MFF for women
average is 225 Hz with range of 180-250
MPT - max phonation time: adults 18-29
21-24 ish seconds
age related changes in larynx include
laryngeal cartilage hardening
age related changes of larynx lead to______
presbyphonia
presbyphonia
age related voice disorder with perceptual changes in quality range loudness and pitch
Perceptual correlate of frequency
PITCH
perceptual correlate of intensity
LOUDNESS or VOLUME
perceptual correlate of complexity
VOICE QUALITY
determined by mass, tension, elasticity of VF’s
PITCH
Jitter is _____
frequency perturbation- variations in vocal frequency- dysphonic patients
Shimmer is _____
amplitude/ loudness perturbation- variation of vocal intensity
A speaker with or without laryngeal pathology will have small variation of intensity per cycle (shimmer is less than 1 dB)
WITHOUT LARYNGEAL PATHOLOGY
Types of vocal quality
on piece of paper - refer to this! *
Before beginning voice therapy it is necessary to obtain
must obtain a medical evaluation of vocal mechanism prior to voice therapy
Indirect laryngoscopy
bright light source and small mirror - press against pharyngeal wall area. view during phonation.
Direct Laryngoscopy
by surgeon under anesthesia - laryngoscope through mouth into pharynx and above VF’s.
Patient can or can’t phonate during direct laryngoscopy
CAN NOT PHONATE DURING THIS PROCEDURE- good for biopsy with laryngeal cancer
Flexible Fiber- Optic Laryngoscopy
thin, flexible tube with fiber- optic light bundles. through nasal passage and above larynx
Can the patient sing or phonate during the flexible fiberoptic laryngoscopy?
YES! they can sing or phonate during this laryngoscopy.
excellent for rapid VF movement
Endoscopy
flexible (nasal) or rigid (orally) - can view VP valving mechanism.
Spectrogram shows ____________
the resonant characteristics of the vocal tract and harmonic nature of glottal sound source
videostroboscopy helps to detect ____
laryngeal neoplasms (tumors) with either a laryngoscope or endoscope
Stroboscopic image from videostroboscopy gives information on the ___ and _____
1) regularity of vocal fold vibration
2) vocal fold amplitude (loudness)
3) glottal closure
4) possible tumors
^^^ given by a ______image
EGG- electroglottography
indirect measure of vocal fold closure patterns
recommended as cross validation tool with other measures of vocal fold functioning
EGG
EMG- electromyography
invasive procedure directly measures laryngeal function to study electrical activity of vocal folds
needle electrodes
EMG looks at _____
vocal fold functioning- muscle activity and activation
Videokymography
high speed medical imaging
Aerodynamic Measurements
airflows, air volumes, average air pressures
Aerodynamic measurements used to evaluate
dysphonia, monitor voice changes, differ between laryngeal and respiratory issues
MPT- max phonation time assesses _____
sustain “a” during one exhalation: respiration, glottal efficiency, vocal pathology
s/z ratio determines if
determines if a laryngeal pathology: produce 2 long /s/ sounds and 2 long /z/ sounds .
divide longest s by longest z FOR RATIO
s/z ratio more than 1.4 indicates ____
possible laryngeal pathology
hypernasality results when
the VP mechanism doesn’t close nasal passage during non-nasal sounds. ( cleft, adenoidectomy, paralysis of velum due to CP, parkinsons)
hypernasality has most affect on 3 manners of artic
1) fricatives
2) affricates
3) plosives
most impacted by this vocal quality
Etiology of VPI
page 288- adenoidectomy, decreased mass of velum
hyponasal patients may exhibit the following
pts with this vocal quality exhibit
1) open mouth breathing
2) enlarged adenoids
frequent hyponasal substitutions
b/m, d/n, g/ng
nasometer
gives visual feedback on computer for oral-nasal ratio - to achieve within normal limits for hypernasal patients
to decrease HYPONASALITY in patient
1) words with nasal sounds said with exaggeration - feel vibrations in mask
2) nasal glide stimulation: combination helps direct resonance into nasal cavity
3) visual aids - mirror or tissue
exaggerating consonants in articulation can alter perception of _______
hypernasal resonance - lessen the extra nasal resonance.
3 categories for laryngeal cancer
T ( site of tumor)
N ( involvement of lymph nodes)
M ( metastasis)
stoma
opening made in lower part of neck for breathing
esophageal voice is produced by ___
PES- pharyngoesophageal segment- vibratory source
Blom- Singer tracheoesophageal puncture TEP
the tracheoesophageal wall ( separates trachea and esophagus) is punctured. device prevents passage of food and liquid into the trachea.
granulomas are vascular lesions usually developed on the
arytenoid cartilages in posterior laryngeal area
Hemangiomas
soft pliable filled with blood- similar to granulomas
usually surgically removed
Leukoplakia
benign white thick patches on mucosa -
sounds low pitched breathy and soft in vocal quality
hyperkeratosis
rough pink lesion in oral, pharynx or larynx
reduced loudness and low pitch
laryngomalacia
epiglottis impacted- abnormal development. epiglottis resists the airstream causing stridor ( rough and breathy noise upon inhalation)
papillomas
primarily in kids and wart like growths by HPV- MANY SURGERIES NEEDED FOR THIS phonation disorder
most concerned about airway preservation
young kids can experience laryngeal trauma by
intake of sharp object
laryngeal web
membrane grows in anterior portion of glottis
PVFM: paradoxical vocal fold motion disorder
aka laryngeal dyskinesia –> inappropriate adduction (closure) of true vocal folds during inhale or exhale.
patients with paradoxical vocal fold disorder appear
asthmatic - some display stridor and dysphonia
ankylosis
movement of arytenoids restricted because of bone disease .
popular technique for vocal fold medialization
thyroplasty type 1 - window in thyroid cartilage and places silastic implant to keep paralyzed fold medialized.
spasmodic dysphonia
laryngeal dystonia
can be abducted or adducted
botox used a lot with hyperadduction cases
MS, MG, ALS, parkinsons
page 301
ALS patients have poor
respiratory control, low pitched monotonous speech
vocal nodules
increase mass of folds, often bilateral, make the folds vibrate at slower rate and result in lower pitch
polyps are unilateral
USUALLY!
patients with polyps sound
breathy and hoarse - diplphonia may be present too.
contact ulcers
ulcerated granulated tissue on posterior third of glottal margin
always ensure____ is completed before voice therapy
medical evaluation must be completed
pharyngeal focus treatment should use
facial mask technique
LOW PITCH VOICE
typically breathy and hoarse
if larynx too elevated and high pitch voice problematic
yawn sigh, open mouth, digital manipulation successful to lower pitch
Lombard effect
patient voice becomes louder in presence of background noise
estrogen does not affect vocal folds
TRUE
techniques for feminine sound voice
greater articulatory precision, softer voice, more modals ( may, will, shall, must)
tongues more anterior in oral cavity during speech
helps achieve forward resonance - characteristic of female voice
female to male gender reassignment can achieve lower pitched voice ( less effort in Female to male )
through hormonal therapy since the testosterone thickens the VF’s and produces lower pitch.
HIGH PITCH
thin and tense vocal folds
LOW PITCH
THICK AND RELAXED VOCAL FOLDS
